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Phototherapy is an important treatment for pigmentary problems, in particular, for vitiligo, which is a common acquired depigmenting skin disease. PUVA therapy, both topical and systemic, has been a mainstay of treatment for years. However, PUVA is associated with an increase in skin malignancies especially with high cumulative sessions of phototherapy. In recent years, NBUVB and the excimer laser/lamp have become increasingly used as the main treatment modalities for vitiligo. The efficacy, relative ease of administration and lower skin carcinogenic risk have made these treatments the phototherapy treatment of choice. NBUVB is widely used for full body phototherapy, but targeted NBUVB devices are also available. Phototherapy with home hand-held phototherapy units has also been shown to have good efficacy with better adherence to treatment. The excimer laser and lamp emit UV light at wavelength of 308 nm and deliver targeted phototherapy. The phototherapy modalities can be combined with other modalities of treatment such as topical calcineurin inhibitors and calcipotriol for greater efficacy. Phototherapy still remains an important, safe and effective treatment for vitiligo.

Epidermolytic acanthoma is an uncommon benign tumor with a predilection for the anogenital region, that is characterized histologically by epidermolytic hyperkeratosis. Most reported cases are asymptomatic while some are pruritic. Treatment of this condition is challenging and not well studied. We report a 55-year-old man with pruritic anogenital epidermolytic acanthomas that persisted despite various topical and ablative therapies, and whose pruritus was not relieved with emollients and antihistamines. He was given 0.1% tacrolimus ointment twice daily and experienced a marked improvement in his pruritus within 2 weeks. At 1 month, there was marked improvement in itch score from 8 to 3.5 (maximum of 10), itch frequency from 20 times a day to once every 4 days, sleep score from 5 to 1 (maximum of 5), and Dermatology Life Quality Index score from 15 to 5 (maximum of 30). Apart from a transient burning sensation, no other adverse effects were noted. To our knowledge, this is the first report of the effective use of a topical calcineurin inhibitor in relieving the intractable itch associated with epidermolytic acanthoma.

SUMMARY A total of 131 new cases of mycosis fungoides and Sezary syndrome were diagnosed clinically and histopathologically at our centre over a 5-year period. There were 87 males and 44 females with a mean age of 36.3 years (range 3–87 years) and no racial predilection. Of the 62 patients (47.3%) with classical mycosis fungoides, the majority were male (male : female = 4.2:1). There was one patient with Sezary syndrome. Patients aged older than 50 years were more likely to present with a longer duration of symptoms and advanced disease. In contrast to classical mycosis fungoides, the 47 patients diagnosed with hypopigmented mycosis fungoides had early stage disease, were younger, and no gender predilection was noted. The mean duration of follow up was 19.7 months (range 0.2–54.8 months). Complete remission was achieved in 24.7% and 53.8% of patients followed up at 1 and 3 years, respectively, using skin-directed and systemic treatment modalities appropriate for the stage of disease. There were five patients with progressive disease and three patients with advanced disease who died from disease-related complications. The most significant prognostic factors for 1-year and 3-year outcomes were the patient’s duration of symptoms and stage of disease at presentation.

Objective: This prospective, patient-controlled study aimed to assess the effectiveness of topical silicone gel sheet and intralesional injections of triamcinolone acetonide (40 mg/ml) in the treatment of keloids.Methods: Twenty patients with multiple keloids were recruited for this study which lasted 12 weeks. In each patient, three keloids of similar size were selected. One was assigned to no' treatment (control) and one to each active treatment. For treatment, patients were instructed to place the sheet over the assigned keloid for 12 h daily for 12 weeks, while intralesional injections of triamcinolone acetonide (40 mg/ml) were administered to the other assigned keloid.Results: None of the untreated control lesions showed any spontaneous reduction in size. Of the lesions treated with silicone gel sheet dressing, only 2 of 17 (12%) showed a significant reduction in size (i.e. at least 50% reduction in size) at week 12. This was not statistically significant when compared with the untreated control lesi...

To determine if watching a children's program on a portable video player reduces anxiety levels in preschool children before cryotherapy for cutaneous viral warts.Nonblinded before-after trial.General dermatology clinic.Consecutive patients aged 2 to 6 years who underwent cryotherapy for cutaneous viral warts.Patients were shown a children's program on a portable video player before cryotherapy.Mean score difference on the modified Yale Preoperative Anxiety Scale between children treated during the 10 weeks before vs the 10 weeks after the intervention was implemented.Ninety-nine cryotherapy sessions performed among 35 children were evaluated. Fifteen children underwent cryotherapy during the preintervention phase only, and 13 children underwent cryotherapy during the intervention phase only. The mean modified Yale Preoperative Anxiety Scale scores were 58.4 during the preintervention phase and 37.7 during the intervention phase (P = .005). The percentages of children with a high anxiety score (≥30) were 100% (15 of 15) during the preintervention phase and 38% (5 of 13) during the intervention phase (P.001). Another 7 children underwent cryotherapy during both the preintervention and intervention phases. Their mean modified Yale Preoperative Anxiety Scale scores were 53.7 during the preintervention phase and 42.0 during the intervention phase (P = .03). The percentages of children with a high anxiety score were 86% (6 of 7) during the intervention phase and 43% (3 of 7) during the intervention phase (P = .25). In both groups, the time spent coaxing and treating children decreased after the intervention, but the differences were not statistically significant.The use of a portable video player significantly reduced preprocedural anxiety levels in preschool children undergoing cryotherapy for cutaneous viral warts.

Hailey–Hailey disease (HHD) or familial benign pemphigus is known to have a chronic relapsing-remitting course. Conventional treatment with topical steroids and antibiotics often yield unsatisfactory results. We report a case of HHD treated successfully with topical cadexomer iodine powder. Cadexomer iodine may be a useful therapy for recalcitrant cases of HHD.

Background The generation of short tandem repeat profiles, also referred to as ‘DNA typing,’ is not currently performed outside the laboratory because the process requires highly skilled technical operators and a controlled laboratory environment and infrastructure with several specialized instruments. The goal of this work was to develop a fully integrated system for the automated generation of short tandem repeat profiles from buccal swab samples, to improve forensic laboratory process flow as well as to enable short tandem repeat profile generation to be performed in police stations and in field-forward military, intelligence, and homeland security settings. Results An integrated system was developed consisting of an injection-molded microfluidic BioChipSet cassette, a ruggedized instrument, and expert system software. For each of five buccal swabs, the system purifies DNA using guanidinium-based lysis and silica binding, amplifies 15 short tandem repeat loci and the amelogenin locus, electrophoretically separates the resulting amplicons, and generates a profile. No operator processing of the samples is required, and the time from swab insertion to profile generation is 84 minutes. All required reagents are contained within the BioChipSet cassette; these consist of a lyophilized polymerase chain reaction mix and liquids for purification and electrophoretic separation. Profiles obtained from fully automated runs demonstrate that the integrated system generates concordant short tandem repeat profiles. The system exhibits single-base resolution from 100 to greater than 500 bases, with inter-run precision with a standard deviation of ±0.05 - 0.10 bases for most alleles. The reagents are stable for at least 6 months at 22°C, and the instrument has been designed and tested to Military Standard 810F for shock and vibration ruggedization. A nontechnical user can operate the system within or outside the laboratory. Conclusions The integrated system represents the first generation of a turnkey approach to short tandem repeat profiling and has the potential for use in both the field (for example, police booking stations, the battlefield, borders and ports) and the forensic laboratory.